Primary care physicians' role perception and self-reported performance in glaucoma care: a survey study.

Albina Rotshtein,Khaled Karkabi,Orit Cohen Castel,Orna Geyer

doi:10.1186/s13104-015-1770-z

Abstract

BackgroundGlaucoma is a leading cause of blindness. The participation of primary care physicians (PCPs) in glaucoma care may improve health outcomes for glaucoma patients.ObjectivesTo investigate PCPs’ attitudes towards their role in glaucoma care, perceived barriers, and self-reported performance in glaucoma management.MethodsPCPs working in the Haifa and Western Galilee District of Clalit Health Services, Israel’s largest Health Maintenance Organization (HMO) were asked to complete a self-administered structured questionnaire. Physicians were asked to rate their agreement with statements describing the PCP’s role in glaucoma care, and to state how often they behave accordingly in their practice. In addition, physicians were asked to rate the extent that factors such as time constraints and knowledge gaps impede their performance in glaucoma care.ResultsEighty-two physicians completed the questionnaire. The majority thought that PCPs have a major role in early detection of glaucoma (99 %), discussing the importance of adherence to treatment (93 %), and encouraging patients to make regular visits to their ophthalmologist (99 %). However, only 30 % reported asking patients about family history of glaucoma, 64 % reported discussing adherence to treatment, and only 35 % stated that they explain how to use eye drops, while most of respondents (87 %) regularly provide refill prescriptions for glaucoma medications. Sixty percent claimed that during their residency they had not acquired adequate knowledge and competence to allow them to take proper care of glaucoma patients. The main barriers reported were lack of time (43 %), lack of knowledge regarding treatment options and recommended follow-up (46 %), and not being familiar with glaucoma medications’ side effects (54 %).ConclusionsThere is a gap between PCPs’ perceptions of their role in glaucoma care and their report on actual performance in early detection and management of glaucoma. Further research is needed to develop and assess interventions that aim at closing this gap.

Highlights

Glaucoma is a leading cause of blindness
In our previous study, which explored factors associated with adherence to glaucoma pharmacotherapy among 738 patients with long-standing glaucoma, we found that primary care physicians (PCPs), in general, are not involved in glaucoma care
Of the respondents included in the analyses, 19 (23 %) were residents in family medicine during hospital rotations, and reported that they could not estimate the number of glaucoma patients they were presently treating, from among all of their patients

Summary

Introduction

The participation of primary care physicians (PCPs) in glaucoma care may improve health outcomes for glaucoma patients. Primary open angle glaucoma (POAG), the most common type of glaucoma, is a leading cause of irreversible blindness, accounting for 2 % of visual impairment and 8 % of blindness globally [1]. Most patients receive IOP-lowering topical medications for the treatment of glaucoma and need lifelong treatment and regular follow-ups to improve outcomes [11]. Adherence to glaucoma pharmacotherapy, defined as the extent to which a patient follows a treatment plan as it was prescribed [12], is often poor, as more than 25 % of glaucoma patients do not take their prescribed medications regularly [13]. Among the key reasons for this are patients’ lack of faith in the necessity of treatment and the fear of using eye drops [14, 15]

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